EYELID SURGERY (UPPER & LOWER EYELID SURGERY)

About Eyelid Surgery (Blepharoplasty)

Individuality is uniquely manifested in our eyes.  No two eyes are the same.  We not only use our eyes to recognize one another, but our eyes are the focal point of facial identification.  Because we use the features around our eyes to give us cues in identifying one another, we quickly notice the signs of aging in this area.  Aging around the eyes (or periorbital region) is one of the first areas to become problematic in both men and women.  Rejuvenation of the eyes can take years of stress and sun damage away creating a subtly refreshed look.

Is Eyelid Surgery (Blepharoplasty) Right For Me?

Eyelid Surgery is a popular procedure for men or women who want to regain a more youthful appearance. Specifically, if you have excess loose skin gathered in your upper eyelids, puffiness above or below your eyes, or fine wrinkles on your lower eyelids you may be a good candidate. People of all ages are enjoying a more rested and youthful appearance after Eyelid Surgery.

Choices In Eyelid Surgery (Blepharoplasty)

At Park Meadows Cosmetic Surgery we are committed to helping you achieve your desired cosmetic goals in and informed and safe manner.  We believe that our patients are sophisticated and capable of understanding and choosing which operations are best for them after appropriate consultation and education with one of our doctors.   We will help you navigate and understand the variety of options available.

UPPER EYELID SURGERY (Upper Blepharoplasty)

Upper Eyelid Surgery is one of the most frequent facial procedures performed.  This procedure is ideal for those people with excess skin, excess puffiness, or both in the upper eyelid region.  By placing a discrete incision within the upper eyelid crease, the excess upper eyelid skin and fatty tissue can be removed and shaped creating a refreshed appearance and crispness to the upper eyelid structure.  This procedure can be performed alone or in conjunction with another facial procedure.  Depending on the patient and the extent of the procedure, Upper Eyelid Surgery can often be performed under local anesthetic. 

As with any cosmetic procedures, there are limiting factors that can affect the ultimate result.  For example, some people have fullness in the outer aspect of their upper eyelids that is not related to excess fat or skin, but due to a prominent tear (lacrimal) gland.  In other patients, a full or droopy brow can contribute to fullness in the upper eyelids that will not improve without a Brow Lift procedure.  Theses nuances that vary from person to person are what our skilled surgeons will help you to better understand so that together, you can choose the exact procedure or procedures to achieve your desired result.  In some instances, surgery may not be recommended either for health related reasons or because a less invasive procedure is more appropriate. 

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INCISION TYPE

LOWER EYELID SURGERY (Lower Blepharoplasty)

Lower Eyelid Surgery is a slightly more involved procedure that can tighten the skin of the lower eyelids and remove puffiness (excess fat) from the lower eyelids.  Lower Eyelid Surgery can be performed with Upper Eyelid Surgery, restoring harmony to the upper third of the face or it can be performed in conjunction with another facial procedure.  Local anesthetic, general anesthesia. or IV sedation can be utilized for Lower Eyelid Surgery.   In some instances, extra support is needed in the lower eyelid and additional tightening of eyelid itself can be performed (canthopexy/canthoplasty).  An incision can be placed just beneath the eyelashes to remove excess skin and puffiness or an incision can be placed inside the eyelid itself if only puffiness needs to be treated.

In other instances, an incision can be placed inside the eyelid to address puffiness and a laser or chemical peel can be used on the skin of the eyelid itself to gently tighten the skin and smooth fine wrinkles on the lower eyelids.  Evaluating exactly which procedure is right for you is the purpose of our complimentary consultation.  As always, it is our goal to provide education and understanding that will assist you in achieving your desired cosmetic result.

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UPPER EYELID SURGERY COMBINED WITH BROW LIFT

Lifting of the brow is often necessary to complement improvement in the upper eyelids. Often this procedure is combined with an Upper Eyelid Procedure to rejuvenate the upper third of the face. Unlike the “surprised” images we see from those in Hollywood who have had obvious Brow Lifting procedures, a Brow Lift should gently shape the brow creating a subtly refreshed and rested appearance enhancing an Upper Eyelid Procedure. Please see the Brow Lift portion of our website to better understand how a Brow Lift may assist you in achieving your cosmetic goals.

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Preparing For Surgery

At least 1 month prior to surgery
Stop smoking at least 1 month prior to your procedure to reduce the risk of postoperative cough and possible bleeding. Smoking reduces circulation to the skin, impedes healing, and can lead to major postoperative complications.

2 weeks prior to surgery
Stop all medications that can thin the blood at least 2 weeks prior to surgery. This includes drugs such as Aspirin, Coumadin, Lovenox, Ibuprofen, Vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery. If you need pain medicine during the 2 weeks prior to surgery, you may use Tylenol.

1 week prior to surgery
Report any signs of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications.

The day before surgery
Do not eat or drink anything after midnight before your surgery. This includes water, ice, or hard candy. The only exception is that you should take your blood pressure or heart medication with a sip of water the morning of surgery.

The day of surgery
Plan to wear comfortable clothes to the procedure. Wear a button down top so it does not have to be put over your head.

Do not wear jewelry or bring valuables with you on the day of surgery.

You may wash your surgical site with regular soap the day before and morning of surgery.

Do not wear cream or makeup on your face the day of surgery.

You must arrange to have a responsible adult drive you home after your procedure.

What To Expect On The Day Of Surgery

When you arrive, you will be escorted to a preoperative evaluation area where you will be asked to change into a gown and will be given foot covers. Your surgeon and the anesthesiologist will meet with you before you enter the operating room suite. During this time, the surgical consent form will be reviewed with you in detail and special markings may be made on your skin at the surgical site. You will have the opportunity to ask any last minute questions.

Once in the operating room, you will be transferred to our padded operating room table. A nurse will start an intravenous drip in your arm and connect you to monitoring devices. The anesthesiologist will give you medication through your intravenous drip to make you feel drowsy.

When your surgery is completed and your dressings are in place, you will be moved to the recovery room. During this period a recovery room nurse will assure your comfort and continue to monitor you closely.

Your stay in the recovery room will last approximately 1 to 1 1/2 hours. Most patients are fully awake within 30 to 60 minutes after their surgery, but may not remember much about their time in the recovery room due to some of the anesthesia medication. Once you are ready for discharge, a postoperative appointment will be scheduled and your discharge instructions will be reviewed.

You must have a responsible adult drive you home from the surgery center. A responsible adult must stay with you the first night after your surgery because you have been sedated.

Post-operative Instructions

Diet: Start with clear liquids and toast or crackers. If those are well tolerated, progress to a regular diet.

Driving: No driving is permitted for the first week or while taking pain medicine. Make sure the swelling of your eyelids has sufficiently resolved for you to see clearly.

Activity: After surgery you may engage in light activity such as walking. You may read or watch television, but expect your vision to be slightly blurred for the first 1 to 2 days. Mildly blurred vision is due to the ointment applied to lubricate and protect the eyes during surgery. No bending, straining, or lifting anything heavier than a gallon of milk for the first 4 weeks. After 6 weeks you may resume more strenuous aerobic work and lifting activities.

Work: Depending on your career and your rate of healing, you should be able to return to work within 2 weeks of surgery. Your surgeon will be able to give you a better estimate depending on your physical and professional profile.

Wound Care: Apply cool compresses to your eyelids for the first 48 to 72 hours as this will help reduce pain and minimize swelling. Place a gauze pad or clean wash cloth into ice water, wring out the water, and place the compress over your eyes. Do not use a warm or hot compress over your eyes until cleared by your doctor in clinic.

Swelling and Discoloration: Moderate swelling and black and blue discoloration around the eyes should be expected during the first several weeks. You may also experience bloodshot eyes, some bleeding from the wound edges, or a feeling of tightness around the eyes. To minimize swelling, keep your head higher than your heart at all times. Sleep with your head and shoulders elevated at a 45-degree angle for the first week.

Bathing: You may shower and wash your hair 48 hours after surgery. Dry off with a towel and use a COOL setting on the blow dryer. Do not submerge the incision in a bath or swimming pool for 4 to 6 weeks.

Medications: Ask you surgeon when you may resume blood-thinning medications. All other prescription medications may be resumed immediately, as usual. While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. You will be given a prescription for antibiotics and should take the full course as directed.

Smoking and Alcohol: Do not smoke for the first several weeks after surgery as it impedes wound healing and can lead to serious wound complications. Smoking also promotes cough, which increases your risk of bleeding. Alcohol consumption is dangerous while taking pain medicine. It has a tendency to worsen bleeding.

Makeup: Do not wear any eye makeup until your surgeon has told you that your incisions are healed, and gives you permission to wear makeup again.

Sun Exposure: If new scars are exposed to the sun, they will tend to become darker and take longer to fade. Make sure you wear a high SPF sunscreen with UVA and UVB protection and or a brimmed hat for the first 6 months after surgery.

Post-operative Appointment:Your first follow-up appointment will be 24 to 48 hours after surgery. Your surgeon will then schedule additional visits at frequent intervals to closely follow your healing process.

Special Considerations: Call your surgeon immediately if you experience any of the following: severe pain not relieved by pain medicine, marked swelling, significant visual changes (anything more than mild blurring), or fever over 101° F, chest pain, shortness of breath, or any other concerning symptoms.  

Surgical Risks

All surgical procedures involve some risks including: the effects of anesthesia, bleeding, infection, pain, and swelling. There are also several possible complications specific to blepharoplasties that occur in a very small percent of people. After reading the discussion below, please contact your surgeon if you have any remaining questions.

Bleeding: Bleeding is usually minimal and well-controlled during the operation.

Hematoma: A hematoma is a collection of blood under the skin. Hematomas typically develop within the first few days after surgery. However, they can occur at anytime after injury to the surgical site. The body can absorb small hematomas. Larger ones require the placement of surgical drains for optimal healing.

Infection: Antibiotics will be given to you prophylactically before surgery and for several days after surgery to minimize the risk of infection. If an infection does develop, it typically can be treated with different antibiotics. In some situations, surgical debridement (removal of the infected tissue) may be required. This can initially result in a larger scar, which may be revised at a later date.

Scarring: All new scars are red, dark pink, or purple. Scars of the face usually fade as they mature within 3 to 6 months. Our objective is to make them as inconspicuous as possible. In some cases broad or raised scars (keloids) develop. After the healing process is complete these can be revised.

Symmetry: Perfect symmetry is rare in nature. There may be some asymmetry between the eyelids. If asymmetry is pronounced or unacceptable to the patient, surgical revision may be performed.

Pain: Mild to moderate pain and discomfort is expected after surgery. You will be given a prescription for pain medication. If you have severe pain not relieved by pain medicine, contact your surgeon immediately.

Delayed Wound Healing or Wound Separation: Several factors can help decrease the risk of poor wound healing or wound separation: good nutritional status, a competent immune system, and not smoking for several months around the time of surgery.

Eye Complications: Lid retraction is when the eyelid does not cover a sufficient amount of the eye. This condition may result in dry eyes. Saline tears will alleviate this situation. Lid retraction may also result in sclera show (this is when the whites of the eye are visible above and below the iris – colored portion of the eye). Ectropion is a rolling outward of the lower eyelid. This may result in excessive tearing, eye irritation, and will likely require corrective surgery. In rare cases blindness may occur.